Can Joint Injections Keep Patients Out of Surgery?

Chronic knee, hip, ankle or shoulder pain does not necessarily mean your next step is into the operating room. For many patients who have sports-related injuries, osteoarthritis, and a family history of OA or who may be overweight and suffer with joint pain, delaying that joint replacement may be an option. Physical therapy and injections into the knee, shoulder, elbow, ankle, wrists, hip bursa, and even some hand injections are possible to combat joint pain according to Shore Physicians Group Orthopedic Surgeon, Dr. Tuan Mickey Bui. “The idea is to delay joint replacement as long as possible while still being bearable,” said Dr. Bui.

Why there is joint pain
All of the body’s joints have their own shock absorbing system. The joint cartilage has special molecules of aggrecan and hyaluronic acid that together provide a hydrated gel structure that gives cartilage load-bearing properties. Dr. Bui says over time those built-in shock absorbers will begin to thin out and break down. “As we age, these molecules degrade. A thinner cartilage is more prone to damage,” said Dr. Bui. “Ironically, when there is ‘full thickness’ area of damage in the cartilage, fluid seeping out from the bone can cause extra fluid in the joint. All of these events increase inflammation in the joint and are the ingredients to make arthritis.”

The body is a great machine with different categories of joints including synovial joints where the bones join together in a cartilage lined cavity filled with fluid. There are pivot, hinge, saddle, plane, condyloid and ball and socket synovial joints. The knee, elbow and fingers are all hinge joints. The neck and vertebrae are pivot joints and the larger ball and socket joints include the hip and shoulder.

Where to start
Before beginning any treatment Dr. Bui said it is first determined where the patient’s joint pain is coming from. “We make sure your pain is due to cartilage damage and not due to anything else in your knee (or other joint). We can prescribe anti-inflamatories, which are stronger versions of what is available over the counter. There are also other types of nerve medications that have shown promising results,” said Dr. Bui.

Physical therapy is another option open to patients experiencing joint pain. “Strengthening the right muscles allows your joints to operate with minimum stress on them. It is like getting a wheel alignment on your car which can lengthen the life of your tires,” said Dr. Bui.

There is help for that pain
Dr. Bui explained that hyaluronic acid used in the injections, also called viscosupplimentation, helps to draw fluid back into the cartilage and helps to restore the joints shock absorbing properties as well as act as a lubricant of sorts. There are a number of different blends of hyaluronic acid, some are made from roosters and the physician said anyone with an allergy to eggs should advise their doctor prior to receiving their injection as there are other formulations available.

Cortisone steroids serve as an anti-inflammatory. (It is not the same as body builders use). Dr. Bui said that reducing the inflammation will reduce the pain. He said his office also gives the hyaluronic acid or viscosupplimentation injections. “In my office, we can give a combination shot of both using only one needle to give the patient the maximum benefit with a minimum of needles,” said Dr. Bui. The normal course of injections is one a week for three or four weeks.

How long can surgery be delayed
There is no set number of times a patient can receive the joint injections before they will need surgery. Dr. Bui said, “There is no limit to the number of times a patient is able to receive the viscosupplimentation but I normally recommend joint replacement when relief from the injections last less than six to eight weeks before the pain returns,” said Dr. Bui. “There are many factors in the decision to have surgery through, and this should be discussed with an orthopedic surgeon.”

To set up an appointment and consultation with Dr. Bui, call Shore Physicians Group-Orthopedic Surgery, 609-365-6280.

Dr. Bui’s specializes in hip and knee pain, minimally invasive knee replacement, unicondylar knee replacement, anterior or posterior hip replacement, anatomic and reverse total shoulder replacement, long bone fractures in fingers and hands, carpel tunnel, trigger fingers, sport related injuries and bursitis of elbow, sport related injuries of the foot and ankle, cortisone injections and viscosupplimentation.